Organization
LAKESIDE PSYCHOLOGICAL CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE M STEVENS PHD (PRESIDENT, PSYCHOLOGIST)
(757) 486-0909
Entity
Organization
Contact information
Practice address
3076 BRICKHOUSE CT, VIRGINIA BEACH, VA 23452-6859
(757) 486-0909
(757) 340-7518
Mailing address
3076 BRICKHOUSE CT, VIRGINIA BEACH, VA 23452-6859
(757) 486-0909
(757) 340-7518
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
90801000970
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104044528
CORPORATE NPI
VA
01
—
1790811040
NPI
VA
Enumeration date
04/23/2007
Last updated
09/01/2010
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